Profiling system for depressive disorder patient using web based approaches PDF

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2012 IEEE Control and System Graduate Research Colloquium (ICSGRC 2012) Profiling System for Depressive Disorder Patient Using Web Based Approaches Lucyantie Mazalan, Nurul Hidayah Mohamed Halim, Hasmila Akmar Omar, Norliza Mohamad Zaini Computer Engineering Department Universiti Teknologi MARA 4045...

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2012 IEEE Control and System Graduate Research Colloquium (ICSGRC 2012)

Profiling System for Depressive Disorder Patient Using Web Based Approaches Lucyantie Mazalan, Nurul Hidayah Mohamed Halim, Hasmila Akmar Omar, Norliza Mohamad Zaini Computer Engineering Department Universiti Teknologi MARA 40450 Shah Alam, Selangor, Malaysia [email protected]

obtain the information and display the depression level of patients to the user of the system.

Abstract—This paper presents the work of design, development and implementation of profiling system for depressive disorder patience. Using a web based approach; the proposed system offers medical organizations that diagnose and treat mental disorders patients to begin the implementation of its automated medical record. The work presented here will replace the existing manual patient profiling. It has profound implications for future records of valuable information about the patient profile, pharmacy activities, and accurate medication history to the concerned health care professionals more quickly and efficiently.

II.

A. Hamilton Depression Rating Scale (HAM-D) The Hamilton Depression Rating Scale (HAM-D) was developed by Max Hamilton in 1960 as a screening tool to measure depressive symptoms that could be used in conjunction with clinical interviews with depressed patients [2]. HAM-D is the most commonly used in depressive rating scales that evaluate the range of symptoms that are most frequently observed in patients with major depression [1]. HAM-D provides an indication of depression and it is also a guide to recovery.

Keywords- Profiling System, Hamilton Depression Rating Scale (HAM-D), Selective Serotonin Reuptake Inhibitors (SSRIs)

I.

INTRODUCTION

A depressive disorder is an illness that involves the body, mood, and mind. It interfere with daily life, normal functioning, and causes pain them self and those who care about him or her. People with a depressive illness cannot merely "pull themselves together" and get better [7]. Without treatment, symptoms can last for weeks, months, or years. Depression is a common but serious illness, and most people who experience it need treatment to get better. An appropriate treatment with a systematic profiling system is vital to help the medical practitioner maintaining systematic and effective patient records. The profiling system components include a screening tool called, Hamilton Depression Rating Scale (HAM-D) for depression screening. It is use to assess the severity of depressive symptoms for individual either children or adults [7] and often used as an outcome measure of depression in evaluations of antidepressant psychotropic medications. It is also used as a standard measure of depression in the research of effectiveness of depression therapies and treatments [7]. The screening can be administered prior to the start of medication during first or follow-up visits, so that medication dosage can be changed based on the patient's test score. For medication dosage, second generation antidepressants are commonly used by the medical practitioners to treat the major depression patients. By implementing a web based technology, the proposed profiling system is designed, developed and integrated using MySQL database, Perl (Xampp) Web server, Hypertext Preprocessor Scripts (PHP), Java Script and Cascading Style Sheet (CSS) to

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SYSTEM COMPONENTS

Hamilton Depression Rating Scale (HAM-D) was designed to be administered by a trained medical practitioners using semi-structured clinical-rated interview. Even though Hamilton did not provided a specific guidelines regarding the administrator and scoring of the scale or any standardized questions for eliciting information from patients, but high reliability has been observed. The original scale had 21 items which contains four additional items measuring symptoms related to depression such as paranoia and obsession. However, Hamilton decided to drop 4 items because it is lack of construct validity. But some continue to use 21 items, and others have expanded the scale to 24 or 28 items. Each item is rated on either a 0–4 or 0–2 scale [3]. The Hamilton interview process is easygoing, informal and there are no specific questions required.

Normal

Mild

Moderate

Severe

Very Severe

0-7

8 - 13

14 - 18

10 - 22

> = 23

Table 1: Scoring for HAM-D relative to the severity of depression level.

In comparison, HAM-D and the others depression questionnaire have some differences. For instance, the HAM-D

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gives more representation to the area of anxiety and physical symptom distress than the others depression questionnaire. It also surveys a wider range of purely psychiatric symptoms than are seen in the different type of depressive questionnaire [10].

patient during their treatment. All of these data are stored and update over a time making it dynamic and efficient.

B. Selective Serotonin Reuptake Inhibitors (SSRIs) Multiple classes of antidepressant medications are available for treatment of depression; it can be divided into three broad classes: first generation, second generation, and third generation medications. The first generation drugs include older medications such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs), while the second generation drugs include many selective serotonin reuptake inhibitors (SSRIs). The third generation medications include drugs that alter both the serotonin and norepinephrine systems [4].

A. System Architecture

III.

The national consensus guidelines suggest second generation antidepressants as the first drug of choice for depressed patients [6], due to their fewer side effects and overdose, as well as their efficiency. SSRI antidepressant is chosen despite of the other classes in the treatment of depression and anxiety in children, teens and the elderly than first generation antidepressants classes that affect both the noradrenergic and serotonergic systems [6] which may cause to death. While the third generation medications include some of the newest drug that will highly effect the blood pressure changes or drowsiness despite of being expensive.

DESIGN COMPONENTS

Figure 1: Web-based Profiling System Architecture

Figure 1 shows the architecture design of the proposed profiling system for depressive disorders. The application layer acts as the presentation layer connected to other components in the system. The client layer of a web application is implemented as a web browser running on the user’s machine. It is the task of the web-based application to display correspond data and let the user of the system to manage the data. When the user submits to the webpage, all the validation is done by the middle tier and any errors are posted back to the client. This is then passed to the presentation layer to display to the users. The presentation layer generates webpage and it includes dynamic content in the webpage that originates from a database. Presentation layer, find the user-entered data and pass that information onto the business logic layer. It is generally implemented inside a Web Server like Apache Web Server.

SSRIs antidepressant; Citalopram (Celexa), Escitalopram (Lexapro), Fluvoxamine (Luvox), Paroxetine (Paxil), Fluoxetine (Prozac), Sertraline (Zoloft) and Venlafaxine (Effexor) are commonly prescribed to treat the symptoms of depression and generally the result can be obtain after 4 weeks of treatment [8]. The first SSRI to be approved by the U.S. Food and Drug Administration was Prozac in 1987 is Fluoxetine [8]. Each SSRI has a certain profile of its own side effects that are including common SSRI side effects like nausea and headache. Fluoxetine was chosen as the first experimental medication during treatment because it eliminated very slowly by the body. The half-life of Fluoxetine after a single dose is two days and, after multiple dosing, four days than its competitors, which range from about 0.5 to 1.5 days [9]. This means that it takes longer to reach steady state and it is only to be taken once a day. Compared to other popular SSRIs, Fluoxetine has a strong energizing effect that makes it highly effective in clinical depression treatment.

Meanwhile, the business logic layer performs all required calculation and validations data and it manage all data access for the presentation layer. This is being implemented by the Application Server that generally automates of services like transactions, security, connection pooling, messaging and name services. The data layer is responsible for managing the data thus providing business logic layer with required data when required and to store data as requested.

C. Database Another component of the proposed system is the database to store all the system related records and data. A database is a collection of information or data that is organized so that it can easily be accessed, managed, and updated. In one view, databases can be classified according to types of content: bibliographic, full-text, numeric, images and it also contain code to perform mathematical and statistical calculations on the data to support queries submitted from web browsers [5]. In detail, the database contain aggregations of data records or files of patient profile containing patient’s information and their medical history, result or data from screening test by using HAM-D and data of SSRIs medication that were given to the

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Phase 2 is to be executed after the completion of Phase 1 as in figure 2(b). For the administrator, they are required to register in prior to get the ID staff to log in into the account, as an administrator. If the administrator did not have their own staff ID, they are required to register and automatically they will get the staff ID to be used in the future. In the other case, if administrator already have their account, but they are forgot their username or password, they are able to do password recovery by entering the email address, where the new password will be sent to the email and the user can create the new password. The administrator is an authorized person and has the permission to view all patient’s information by searching based on patient’s IC number. If the patient’s record does not exist in the system, users need to insert the data first. Administrator is able to update the existing data inserted by medical practitioners that act as normal users.

B. System Flow

Figure 2 (a): Flowchart of Profiling System Phase 1 (User Authentication)

This profiling system consists of login authorization for administrator and medical practitioner. In Phase 1, the medical practitioner acts as a normal user need to checked the patient’s record whether it is already in the database, by insert patient’s IC number. If the IC number not detected, the user is allowed to insert new record of patient’s information. Suitable setting is chosen in order to be connected. This process will be repeated until the information is successfully recorded.

Figure 2 (c): Flowchart of Profiling System Phase 3

This profiling system also included a Hamilton Depression Rating Scale (HAM-D) as screening tools, to measure depressive symptoms that be used for clinical interviews with depressed patients. The score numbers of depression will automatically display in the score box by the end of the interview session. The scoring number shows the level of depression that can be divided into five classes; normal, mild,

Figure 2 (b): Flowchart of Profiling System Phase 2 (Administrator’s Role)

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core functions, methods, and objects with dynamic PHP coding.

moderate, severe and very severe. Phase 4 shows if the patient’s have the score rate in normal and mild classes that means they did not have depression symptom which requires a special treatment where they can discharge from having depression illness.

2) MYSQL Database: The database is used to store administrator account information, patient personal information, patient medication history, and patient treatment records. The database platform has admin, password, hamd, medicalform, patientprofile, and record table. Admin table created to store the admin’s information that has been register. The password table is created to save all the changes password of administrator in case of forgotten their password. The hamd table is created to store the data of patient during HAM-D treatment. The patientprofile and medicalform table is created for the system to save the detail patient’s information. Finally, the record table is created to store patient’s IC number that can be used to trace the patient’s information.

During the depression test by HAM-D, if the patient has the scoring in moderate, severe and very severe classes, it means the patient have depressive symptoms. As a diagnosis example, a medical practitioner diagnoses the patient by issuing the second generation antidepressant; Fluoxetine starting with the low doses where it needs to be taken up for at least 6 weeks to reach the effectiveness.

IV.

RESULT AND DISCUSSION

A. Graphical User Interfaces (GUI) Figure 3 (a) shows the Login Form when the administrators create their own account during the system registration. The purpose of this login is to ensure the security of the system from unwanted access. The login system filled with required system access, having a password recovery in case of password disremembered and they are able to reset current password so does creating a new ones. Figure 3 (b) shows the Patient Record page when the clinician is successfully entering the system. The clinician can view all details information of their patients as a reference during the appointment by entering the patient’s IC number. Figure 3 (c) and (d) shows GUI of Patient Profile and Medication History. This system architecture, user graphical interface is design for users and administrator but there is several different kind of access from users. For administrator, all information about patients is display on these pages after the IC number was entered. Besides, the administrator can also update existing patient information and send the data to be stored in database. This conversion provides structured data format that would be recognized by the back-end systems in the medical organization and makes it easier for clinician to update patient data each time during an appointment. In the other hand, for normal user, this interface was design to insert new information about patient, so that the clinician can refer to the information that is already in the database.

Figure 2 (d): Flowchart of Profiling System Phase 4

After 6 weeks under Fluoxetine treatment, clinician needs to monitor the effectiveness of Fluoxetine to the patient. If the patient have some improvement but not completely recovered, then the clinician should extend the clinical trial for another 6 weeks with same medication. During the treatment, clinician needs to treat the patient at regular visit for at least the first 12 weeks of treatment. The medication will be change to others type of second generation antidepressant drugs, if Fluoxetine has no more suitability. Nevertheless this will depends on the medical expertise and experienced clinician with the help of the profiling system.

Figure 3 (e) shows graphical user interface of HAM-D treatment that are mostly used by clinician to measure a depressive symptoms of patient. This screening tool consist of 21 questions that need to answer by patient, it takes around 20 minutes. In the end of this interview, the result of the interview are display in the total score box. The score indicate the level of depression.

C. Software Development and Implementation 1) Adobe Dreamweaver CS5: Adobe Dreamweaver CS5 is the industry-leading web authoring and editing software that provides both visual and code-level capabilities for creating standards-based websites and designs for the desktop, smartphones, tablets, and other devices. Adobe Dreamweaver CS5 design and develop in an environment that supports most leading web development technologies, including HTML, XHTML, CSS, XML, JavaScript, Ajax, PHP, and ASP. It also build and maintain PHP applications getting direct insight into

Figure 3 (f) shows the interface of the next treatment that needs to be given to the patient by the clinician from the result of HAM-D. Second Generation Antidepressants that are commonly used include many selective serotonin reuptake inhibitors (SSRIs) as mentioned.

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Figure 3 (f)

Figure 3 (a)

Figure 3: (a) GUI of Login Form, (b) GUI of Patient Record, (c) GUI of Patient Profile, (d) GUI of Medication History, (e) GUI of HAM-D Treatment, (f) GUI of Second Generation Antidepressants

B. System Testing 1) Functionality Testing: The proposed system has undergone few systems testing as part of its system application development process. Functionality testing executed to determine whether the application implements the capabilities correctly. Each graphical user interface of Profiling System work successfully. All data that are entered into each of GUI will be submitted and stored into database and displayed to the GUI once the users or administrator enters the patient’s IC number. Besides that, the Profiling System can successfully generate proper total score in the antidepressant GUI. A clinician that acts as administrator can edit and update the patient’s information and save it into database to replace the old data.

Figure 3 (b)

2) Non-Functionality Testing: Non-functionality testing is done to determine whether the functionally of the system provides adequate response. The objective of the project to make the system as systematic and full-filled the requirement of an automatic profiling system. The graphical user interfaces are linked to the correct pages and work as planned. Furthermore, this profiling system comes with a necessary login function for administrator to access the account. First of all, an administrator must create administrator account to access the system. Once they have their own username and password they can login into the system. If they are forgot their password, they must retrieve the password to get the new password. After login, database will matched the password either the password combination is valid. If invalid, user must retry to login back. When password is matching, a clinician can be access the Profiling System. To exit from the system, they must logout. This login system is used for administrator only to prevent the data and information of patient’s from displayed to public due to confidentiality issue.

Figure 3 (c)

Figure 3 (d)

V.

CONCLUSION

As technology advances, particularly in the area of information and communication that are keep growing on daily basis, taking advantage and keeping abreast of these technologies is a paramount concern to users in order to reduce problems that have been faced by health care provider in searching the patient information particularly in treating depression disorders. Profiling System for Depressive Disorder Patient was designed as one of web application which replaced the manual patient profiling. It offers valuable information

Figure 3 (e)

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